DOL Form CA-5

View OWCP-DFEC's Form CA-5 Online htm

Agency:

OWCP-DFEC

Title:

DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children

Form Description:

DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children: A deceased federal employee's widow, widower, and/or children may use this form to claim work-related death benefits.

OMB Control Number:

1215-0155